人生五十始衰，过此以往，全赖随时节养，设或勤劳太过，则衰甚矣。癸巳夏季，应试入都，贵大司寇来延余诊。据云：去冬即有小恙，至春其恙大发，医药迭进，转重转剧，延今数月，食不甘，寐不安，面烧齿浮，溺涩便涩，心悸汗出，肢弱体疲，耳不足于听，目不足于视，语不足于音，一切精神，尤为惝恍。余切其脉，浮举似弦，沉按又微，知是血气大亏，风阳不潜所致。先用济阳熄风之剂，加补益以佐之，五盲稍可用，四肢较有力矣。再用补气养血之剂，频增减以治之。心神虽不足，眠食可如常矣，余症亦就痊矣。原此症由来，因子日劳心太过，精气受戕，遣病起初，又治失其宜，所以衰羸至此。前于虚人感冒症，特申扶正怯邪，标本兼顾之说，盖欲主治者，遇此等虚弱证情，为之早筹全局也。至论病后摄养，要药有二，大法有三。所谓二者何?一曰鹿茸，二日人参，盖非茸不能补督脉之精，非参不能补五藏之气。所谓三者何?一曰益，二曰复，三日恒，益者益其正气，复者复其元精，恒者恒久而后奏功。窃见今人，有病后失手调理，终身羸弱不堪者，是气之伤也。有病未复元，即起劳役，时愈时坏，后竟无可挽回昔，是精之夺也。有病愈后，急需调养，听人讹说，谓补药不宜多服，因循自误者，是功败于垂成也。惟有明理入，知精与气为吾身至宝，既亏损于前，思补救于后，当病后元气未复，除药饵外，起居必慎，饮食必调，虽累月累年，不忍或劳，非自逸也。盖养气蓄精，犹欲出其身以有为，不敢轻于尝试也。则圣贤存心养性之功也。
气血两损弱证
人生二十曰弱，弱者，血气未充之谓。当血气未充时，劳乏以致疾，怯损矣成。己丑，内亲蒋丙炎，时十九岁，四月中，害目赤方愈，五月初，即应试澄江，北返，又病暑温，时而治愈，时而劳复，如是者数旬。其家疑医药无功，祷于神，服仙方，月余，病益剧，速余往视。脉细如丝而数，忽寒忽热，咳嗽喘促，口吐清涎，间有红丝，自汗腹痛，室中略行数武，汗喘即甚，痿顿不堪。其家问病可治否，余答曰：怯损已成，姑念年少，试设法以挽回之。用十全大补汤、生脉散、香砂六君丸等方，出入加减治之。数旬后，忽壮热不退，知是感冒外邪所致，另用紫苏煎汤冲饮，得微汗，热即退。又数旬，忽腹痛下痢，知是正气得理，邪无所容故，另加川连数分，因势利导之，痛痢即止。又数旬，因怒火上升，忽于午煎，面赤神昏，两足逆冷，知是命火上泛，非引火归元不可。另以金匮肾气丸一两，分作三服，交已刻，先用开水送下，井用火炉烘足，浮火即平。是症也，共治百数十日，症虽屡变，所药不变，随时随症，略加数味而已，居然逐决赛功，终收全效。使所见不确，施治不专，有不因循贻误者乎。追病愈后，里中有老者见之，惊为异，踵余门，求治数十年老病。余曰；某病所以能挽回，固由医药功，亦由年华富。盖年未弱冠谓之少，年将花甲渭之耆。少如春初草，勾萌甫达，常存生长之机，耆如秋后林，枝叶虽繁，隐寓衰残之象也。惟事亦不必以常理拘耳。尝见世之人，老而强，每胜于少而弱，是知人定亦许胜天，齐邱子曰：松柏之所以能凌霜者，藏正气也，美玉之所以能犯火者，蓄至精也。惟人亦然，子能藏气蓄精，即却病延年之道矣。书一调补方与之，老者乃欣然而去。
咳嗽内外因证
肺为五藏华盖，体本清虚，一物不容，毫毛必咳，有外感六气而嗽者，有内伤七情六欲而嗽者。治当先其所因。癸巳冬，余寓天津，高君诚斋之室，晨起即嗽，至暮尤甚，连咳不止，延余往诊。切其脉，浮虚细数，知是寒束于表，阳气并于胸中，不得泄越所致。闲利膈煎治之，下咽即安。又曹某，每日午后，必发干咳敷声，病已年余，问治于余。切其脉，六部中惟左尺沉按则数，知阴分至深处，有宿火内伏，故午后阴气用事时，上冲于肺而咳。朱丹溪所谓火郁之干咳嗽，症最难治也，余用杞菊地黄丸意，加减治之，十余剂而愈。丙申冬，余又至天津，周菁莪大令患咳嗽症甚剧，终夜不得卧，来速余诊，切其脉，六部细数，有关尺按尤有力，知是大畅温邪，上乘于肺而咳。用芩知泻火汤加减，十数剂而治愈。丁酉夏初，江君镜泉子后午前，咳嗽痰多，并见筋骨酸痛，食少神疲等症。余诊之，脉来缓弱，知是脾虚寒侵，用理中汤加味，温补而愈，此数症也，或表或里，或虚或实，或寒或热，如法施治，应手奏效。故先哲有言，咳嗽虽责之肺；而治法不专在肺，诚以咳嗽受病处，不尽属于肺也。今人但知咳不离乎肺，凡见咳嗽，即以辛药治之，一切咳嗽不因于肺者，缠绵不已，永无愈期。追至劳症将成，乃归咎于肺气不充，与肺阴不足。今试问气何以不充，阴何以不足，非缘过服辛药，肺经受伤之故欤。使能先其所因，不沾沾于治帅，则咳早平而金不受困，其得失为何如耶。
吐血一症，有心肝脾肺肾之分，或咳血，或呕血，或唾血，或咯血，或间血丝，或成盆或碗，辨清表里阴阳寒热虚实，按症施治，无不愈者。特恐病家自认为劳，医家亦误认为劳，畏首畏尾，因循从事，贻误滋多。庚寅冬，余客济南，杨君景澄病咳嗽吐红，医用地褕、归尾，前胡，橘红等药治之，旬有余日，转重转剧，来延余诊。切其脉，濡而数，右尺独疾，舌跟有紧贴黄色薄苔，明是大肠火逆，上灼肺金，咳伤血膜，血随痰出。遂宗朱丹溪法，用三黄泻心汤加味，数剂，吐红止，咳嗽平。后又减三黄加参芪，调理而愈。丙申正月初，余旋里，吾友李经谊病。据云：初起不过咳嗽，末几气喘，未几吐血，延今月余，病益加剧，腰痛不堪。余切其脉，右尺滑疾，明是大肠火盛，上冲于肺所致。用槐花降气汤一剂，大便下紫黑血，咳喘渐平。再剂，吐血止，腰痛轻。后承是方加减而愈。此二君也，一则体瘦，一则体肥。肥人多湿，故燥而清之；瘦人恶燥，故润而清之。受病虽同，用药是异，未可混施耳。或以泻心方用大黄苦寒为疑，余曰：火盛则血不归经，用大黄无他，不过泻亢甚之火耳。李士材曰；古人用大黄以治虚劳吐衄，意甚深微，盖浊阴不降，则清阳不升，瘀血不去，则新血不生也。所恐俗工辨症不明，遇内伤挟寒，亦用大黄，罔不杀人。盖阳虚阴必越，营气虚散，血亦错行，须用理中汤甘草干姜汤以温其中，血始归经。较前二症，或寒或热，有天壤之别，不可不知。
喘之为病，有风寒，有暑湿，有痰壅，有气郁，有水气上泛，有火邪上冲，致喘者不一端，要不越表里寒热虚实之分，先哲有言，治病以辨症为急，而辨喘症为尤急，盖见庸工治喘，拘守偏见，不能随症施治也。兹姑举其一。王辰秋，余至天津，适张汉卿观察病气喘甚剧，终夜不得卧，绵延已月余，邀余往诊。脉虚细数，审是夏季伏暑未清，阴虚火升为患；用润气汤加石羔，一剂，喘嗽严，能安睡矣。后承是意加减，两旬余而愈。当初治时，有闻方中用石羔，传为大谬者。愚思症起六月，暑邪内伏，非石羔不解，何谬之有?彼以石羔为谬者，殆患喘而不敢用石羔者也。否则辨证不明，误用石羔治寒喘，未得其法者也。夫仲景续命汤、越婢汤等方，俱加石羔以为固势利导之捷诀。李士材治烦暑致喘，用白虎汤。古人治火邪上冲，喘不得息者，罔不藉石羔以为功。盖暑喘用石羔，犹之寒喘用干姜，虚喘用人参，实喘用苏子，不遇其症则已，既遇其症，必用无疑。俗流信口雌黄，原不足辨，所不能不辨者，此等喘症最顽，愈未几时，条焉又发，投剂稍差，贻误非小。丙申冬，刘伟斋大令之令郎，病喘甚剧，数日一发，发则头痛身热，转侧呻吟，苦不可堪，余切其脉，右部虚数，左更微不可辨，按久，又似有数疾情状，知是阴虚阳盛，与以冬地三黄汤，喘势渐平。继减三黄进以参芪，调养而痊。丁酉夏，因劳复发，他医以头痛身热为外感，而用温疏，以形瘦脉微为中虚，而与补益，病势又剧。余仍前清养治法之，旬余而愈。可见喘系宿疾，多由气质之偏，不得以寻常脉证相例，总恃临证者，随时论病，随病论治，阴阳虚实，辨得清耳。
呕哕虚寒证
呕哕有气血多少之分，有寒热虚实之异。实而热者，清之泻之，可以即瘳；虚而寒者，温之补之，不能速愈。王辰秋，余客天津，张鸿卿观察来速余诊，据云，夙病呕吐，延今偶触凉风，即泛冷涎，若将哕逆者然。余切其脉，沉细而迟，知是积寒久郎，非用大热药，不足消沉瘤之逆冷，不能复耗散之元阳，用四逆汤加味，重剂与之，每剂用附于一两，共服至百数十剂，宿恙始痊。或问，附子察雄壮之质，用至一两，不嫌多乎?答曰：大寒症，非用斩关夺将之药不治，惟附子能通行十二经，无所不至，暖脾胃，通瞒噎，疗呃逆，同干姜则热，同人参则补，同白术则除寒湿如神，为退阴回阳必用之味。近世疑而不用，直待阴极阳竭，而用已迟矣。古人于伤寒阴证厥逆直中三阴，及中寒来阴，虽身热而脉细，或虚浮无力者，惧用附子以温理之。或厥冷腹痛脉沉细，甚则唇青囊缩者，急须生附以温散之，东垣治阴盛格阳，面赤目赤，烦渴引饮，脉来七八至，按之即散者，余入都，闻有一人病火冲头痛颇重，延西医治之，用猪脬五，盛冰于中，头顶前后左右各悬其一。彼以为邪火上冲，用寒冰遏之，则火衰而痛可干。不知寒从外逼，火将内攻，症之轻者，不过多延时日，或可无虞，若遇重症，尤恐火气攻心，挽回莫及。在西人以寒治热，较俗工以风助火，已胜一筹，然何如用清下法折之，一服即平为愈乎。
面痛虚寒证
面为阳明部分，而阳维脉起于诸阳之会，皆在于面，故面痛多属于火。惟火有虚火，有实火。实者可清，虚者不可清，乙未，余客上海，有张姓妾，小产后，两眼中间，常有一星作痛，病已经年，问之渚医，莫名所以然。余切其脉，细弱而迟，知是平素血亏，小产后，血尤亏，血亏则气亏，气亏即火亏。遂合当归补血汤胶艾汤加吴萸、牛膝、肉桂为方，温补而愈，考《内经》察色篇，以两眼之间属心。经又云，心之合脉也。又云：诸脉皆属于目。西医亦云；心体跳动不休，周身血脉应之而动。可知脉为心血贯注之所，目又为血脉交会之所，今两眼间作痛，其为心中血虚无疑。何则?经云：诸痛皆属于心。又云：诸痛皆属于势。又云；心主血，心恶热。夫热，阳也。血，阴也。阴非阳不生，阴非阳不守，阴耗则阳气独吐，无所依附，势必循脉上浮，凑于两眼之间，安得不痛。余以补血为君。补气为臣，补火为佐，引热下行为使，病果应手而效。在麻衣相法，指两眼中央为山根，吾将以山根痛名之，附手眉棱痛、眼眶痈之后云。
心胸痛虚寒证
心痛一症，《灵枢》有肾心痛、胃心痛、脾心痛、肝心痛、肺心痛、真心痛之分。盖五藏之滞，皆为心痛。《金匮》用九痛丸，治九种心痛。后人以饮食气血寒热悸虫疰别之。虽祖此义，实未尽《内经》之旨，约丽论之，要不越阴阳虚实。然实而属阳者易瘳，虚而属阴者难愈。庚寅冬，余至山东，有友朱汉胎患心胸痛，或数日一发，或一日数发，如是者六七年。余切其脉，濡数少神，知是肝脾心痛，既寒且虚，与以温补重剂，服之，有小效，无大效。因思症系中空，甘草可满中，并能缓急止痛，仍前方加炙甘草至壹两，痛果大愈。但此症由境遇不遂所致，且患已数年，除根不易。其时有谓炙草一味，前方已用五钱，今又加至壹两，毋乃太多者。余曰；甘草生用气平，炙用气温，其性能协和诸药，故有国老之称。昔仲景甘草汤、甘草芍药汤、甘草茯苓汤、炙甘草汤，以及麻黄，桂枝、葛根、青龙。理中、四逆、调胃，建中、柴胡、白虎等汤，无不重用甘草，惟遇呕吐肿满，酒客诸湿症，概禁不用，则以用药治病有宜忌之分也。世俗治病，下明宜忌，甘草一味，重用不敢，不用不能，凡立一方，但用数分，以为如此，乃两全之汁也。不知其计愈巧，其识愈庸。汪词庵曰：时医用甘草，不过二三分而止，不知始自何人，相习成风，审不可破，殊属可笑。曷为可笑，盖笑其庸耳。
腹痛宿证
腹痛一症，有热，育寒，育气，有血，有浊，有虫，有实，有虚，有内停饮食，有外感风寒，有霍乱，有内扁。治苟如法，虽数年宿恙，不难应手奏功。壬辰冬，余寓天津，苏州严某，每于申时后，子时前，腹中中作痛，上乘胸脘，甚至呕吐，静养则痛轻而缓，劳乏则痛重而急，病经十年，医治不效。余切其脉，虚细中见弦数象，知是气血两亏之体，中有酒积未清，故至申于二时，蠢然欲动。尝见书载祝由科所治腹痛症一则，与此情形颇合，惟彼专去病，故用二陈汤加川连、神曲，葛根、砂仁，而此则病经多年，正气既虚，阴血亦损。法当标本兼顾，因师其方，加参术地芍治之。服至十数剂，病果由重而轻，由轻而痊矣。当此症初愈时，十年夙恙，一旦奏功，入闻其异，索方视之，以为效固神奇，药乃干淡，莫名所以然。殊不知治病原无别法，不过对症用药而已。药与症合，木屑尘根，皆生人妙品，岂必灵芝仙草，始足却病以延年。
少腹痛火证
人生到了五十岁才开始衰老，过了这个年纪，全靠顺应时节来调养。如果劳累过度，衰老就会更加严重。癸巳年夏季，我进京参加科举考试，贵大司寇（官职名）邀请我为他诊病。他说：去年冬天就有小病，到了春天病情加重，医药不断进服，反而越来越重，延续到现在几个月了，吃饭不香，睡觉不安稳，面部发热，牙齿感觉浮起，小便涩滞，大便不畅，心悸出汗，四肢无力身体疲倦，耳朵听力下降，眼睛视力减退，说话声音微弱，精神恍惚不定。我把脉，轻取像弦脉，重按又微细，知道这是气血大亏，风阳不能潜藏所致。先用济阳熄风的方剂，加上补益的药物辅助治疗，五天后稍微见效，四肢比较有力量了。再用补气养血的方剂，频繁增减药物来治疗。心神虽然不足，但睡眠饮食可以恢复正常了，其他症状也痊愈了。推究这个病的起因，是因为平日劳心太过，精气受到损伤，发病初期，治疗又不适宜，所以衰弱到这种地步。先前在虚人感冒的病症中，特别阐述扶助正气、驱除邪气，标本兼顾的说法，大概是希望主治医生，遇到这种虚弱的证情，能及早筹划全局。至于论及病后调养，重要的药有两味，大法有三条。所谓两味是什么？一是鹿茸，二是人参，大概不是鹿茸不能补督脉的精气，不是人参不能补五脏的气。所谓三条是什么？一是益，二是复，三是恒。益是补益正气，复是恢复元精，恒是持久坚持才能见效。我看见现在的人，有病后调理失当，终身瘦弱不堪的，这是气的损伤。有病未恢复元气，就起来从事劳动，时好时坏，后来竟然无法挽回，这是精的耗夺。有病愈后，急需调养，听信别人的错误说法，认为补药不宜多服，因循拖延自己耽误自己的，这是功败垂成。只有明白道理的人，知道精和气是我们身体的至宝，既然在前面亏损了，想在后面补救，应当在病后元气未恢复时，除了用药外，起居必须谨慎，饮食必须调和，即使累月累年，不忍心稍加劳累，这并不是为了安逸。因为养气蓄精，就像想要有所作为一样，不敢轻易尝试。这就是圣贤存心养性的功夫。
气血两损弱证
人生二十岁称为弱，弱，是指血气没有充盈的意思。当血气没有充盈的时候，疲劳导致生病，怯弱损耗就已经形成了。己丑年，我的内亲蒋丙炎，当时十九岁，四月间，患眼疾刚痊愈，五月初，就去澄江参加科举考试，北返途中，又患上暑温病，时而治愈，时而因劳累复发，像这样几十天。他的家人怀疑医药没有功效，向神灵祈祷，服用仙方，一个多月，病情更加严重，急忙请我去看。脉象细如丝且数，忽冷忽热，咳嗽气喘，口吐清涎，间或有红丝，自汗腹痛，在房间里走几步路，汗出气喘就加重，痿顿不堪。他的家人问病可治吗，我回答说：怯损已经形成，姑且念他年轻，试着设法挽回。用十全大补汤、生脉散、香砂六君丸等方剂，出入加减治疗。几十天后，忽然壮热不退，知道是感冒外邪所致，另外用紫苏煎汤冲饮，得到微微出汗，热就退了。又过几十天，忽然腹痛下痢，知道是正气得理，邪气无处容身，另外加川连几钱，因势利导，痛痢就止住了。又过几十天，因为怒火上升，忽然在中午，面赤神昏，两脚逆冷，知道是命火上泛，非引火归元不可。另外用金匮肾气丸一两，分作三次服用，交巳刻（上午9-11点），先用开水送下，并用火炉烘脚，浮火就平了。这个病，共治疗一百多天，症状虽然多次变化，所用的药不变，随时随症，略加几味药而已，居然逐渐见效，最终收到全效。如果见解不确切，施治不专一，难道不会因循延误吗？等到病愈后，乡里有老人看见，惊讶为奇异，来到我家门口，求治几十年的老病。我说：某病之所以能挽回，固然由医药的功效，也是由年华富盛。大概年龄不到二十岁称为少，年龄将近六十岁称为耆。少就像初春的草，萌芽刚刚到达，常存生长的生机；耆就像秋后的树林，枝叶虽然繁茂，隐含衰残的景象。只是事情也不必被常理拘束罢了。曾见世上的人，年老而强壮，往往胜过年少而虚弱，这是知道人力也可以胜天，齐邱子说：松柏之所以能凌霜，是因为藏有正气；美玉之所以能犯火，是因为蓄积至精。人也一样，你能藏气蓄精，就是却病延年的道了。写一个调补方给他，老者才高兴地离开。
咳嗽内外因证
肺是五脏的华盖，体本清虚，不容异物，毫毛必咳，有外感六气而咳嗽的，有内伤七情六欲而咳嗽的。治疗应当先找出病因。癸巳年冬天，我住在天津，高君诚斋的妻子，早晨起床就咳嗽，到晚上尤其严重，连续咳嗽不止，请我去诊。切她的脉，浮虚细数，知道是寒邪束缚于表，阳气并于胸中，不得泄越所致。用利膈煎治疗，下咽即安。又有曹某，每天午后，必发干咳几声，病已一年多，向我求治。切他的脉，六部中只有左尺沉按时则数，知道阴分最深处，有宿火内伏，所以午后阴气主事时，上冲于肺而咳。朱丹溪所说的火郁之干咳嗽，症状最难治，我用杞菊地黄丸的意思，加减治疗，十几剂而愈。丙申年冬天，我又到天津，周菁莪大令患咳嗽症很剧烈，整夜不能卧，急忙请我去诊，切他的脉，六部细数，关尺按尤有力，知道是大肠温邪，上乘于肺而咳。用芩知泻火汤加减，十数剂而治愈。丁酉年夏初，江君镜泉的儿子，午前咳嗽痰多，并见筋骨酸痛，食少神疲等症状。我诊之，脉来缓弱，知道是脾虚寒侵，用理中汤加味，温补而愈，这几个病，或表或里，或虚或实，或寒或热，依法施治，应手奏效。所以先哲有言，咳嗽虽然责之于肺；但治法不专在肺，诚然咳嗽受病处，不尽属于肺也。现在的人只知道咳不离乎肺，凡见咳嗽，就用辛药治疗，一切咳嗽不因于肺的，缠绵不已，永无愈期。等到劳症将成，才归咎于肺气不充，与肺阴不足。现在试问气何以不充，阴何以不足，不是缘于过服辛药，肺经受伤的缘故吗？如果能先其所因，不沾沾于治肺，那么咳早平而金不受困，其得失为何如耶。
吐血一症，有心肝脾肺肾之分，或咳血，或呕血，或唾血，或咯血，或间血丝，或成盆或碗，辨清表里阴阳寒热虚实，按症施治，无不愈者。只怕病家自认为是劳损，医家也误认为是劳损，畏首畏尾，因循从事，贻误滋多。庚寅年冬天，我客居济南，杨君景澄病咳嗽吐红，医生用地榆、归尾、前胡、橘红等药治疗，十几天，转重转剧，来请我诊。切他的脉，濡而数，右尺独疾，舌根有紧贴黄色薄苔，明是大肠火逆，上灼肺金，咳伤血膜，血随痰出。于是宗朱丹溪法，用三黄泻心汤加味，几剂，吐红止，咳嗽平。后来又减三黄加参芪，调理而愈。丙申年正月初，我回故乡，我的朋友李经谊病。据说：起初不过咳嗽，不久气喘，不久吐血，延续到现在一个月多，病更加剧，腰痛不堪。我切他的脉，右尺滑疾，明是大肠火盛，上冲于肺所致。用槐花降气汤一剂，大便下紫黑血，咳喘渐平。再剂，吐血止，腰痛轻。后来承是方加减而愈。这两位病人，一个体瘦，一个体肥。肥人多湿，所以燥而清之；瘦人恶燥，所以润而清之。受病虽同，用药是异，不可混施耳。有人或以泻心方用大黄苦寒为疑，我说：火盛则血不归经，用大黄无他，不过泻亢甚之火耳。李士材说：古人用大黄以治虚劳吐衄，意甚深微，盖浊阴不降，则清阳不升，瘀血不去，则新血不生也。所怕俗工辨症不明，遇内伤挟寒，也用大黄，罔不杀人。盖阳虚阴必越，营气虚散，血亦错行，须用理中汤甘草干姜汤以温其中，血始归经。较前二症，或寒或热，有天壤之别，不可不知。
喘之为病，有风寒，有暑湿，有痰壅，有气郁，有水气上泛，有火邪上冲，致喘者不一端，要不越表里寒热虚实之分，先哲有言，治病以辨症为急，而辨喘症为尤急，盖见庸工治喘，拘守偏见，不能随症施治也。兹姑举其一。王辰秋，我到天津，适逢张汉卿观察病气喘很剧烈，整夜不能卧，绵延已月余，邀我去诊。脉虚细数，审是夏季伏暑未清，阴虚火升为患；用润气汤加石膏，一剂，喘嗽严，能安睡矣。后来承是意加减，两旬余而愈。当初治时，有闻方中用石膏，传为大谬者。愚思症起六月，暑邪内伏，非石膏不解，何谬之有？彼以石膏为谬者，殆患喘而不敢用石膏者也。否则辨证不明，误用石膏治寒喘，未得其法者也。夫仲景续命汤、越婢汤等方，俱加石膏以为固势利导之捷诀。李士材治烦暑致喘，用白虎汤。古人治火邪上冲，喘不得息者，罔不藉石膏以为功。盖暑喘用石膏，犹之寒喘用干姜，虚喘用人参，实喘用苏子，不遇其症则已，既遇其症，必用无疑。俗流信口雌黄，原不足辨，所不能不辨者，此等喘症最顽，愈未几时，倏焉又发，投剂稍差，贻误非小。丙申年冬天，刘伟斋大令的儿子，病喘很剧烈，数日一发，发则头痛身热，转侧呻吟，苦不可堪，我切他的脉，右部虚数，左更微不可辨，按久，又似有数疾情状，知道是阴虚阳盛，给予冬地三黄汤，喘势渐平。继减三黄进以参芪，调养而痊。丁酉年夏天，因劳复发，他医以头痛身热为外感，而用温疏，以形瘦脉微为中虚，而与补益，病势又剧。我仍前清养治法之，旬余而愈。可见喘系宿疾，多由气质之偏，不得以寻常脉证相例，总恃临证者，随时论病，随病论治，阴阳虚实，辨得清耳。
呕哕虚寒证
呕哕有气血多少之分，有寒热虚实之异。实而热者，清之泻之，可以即瘳；虚而寒者，温之补之，不能速愈。王辰秋，我客居天津，张鸿卿观察来请我诊，据说，夙病呕吐，延续到现在偶尔触凉风，即泛冷涎，若将哕逆者然。我切他的脉，沉细而迟，知道是积寒久留，非用大热药，不足消沉瘤之逆冷，不能复耗散之元阳，用四逆汤加味，重剂与之，每剂用附子一两，共服至百数十剂，宿恙始痊。有人问，附子察雄壮之质，用至一两，不嫌多乎？回答说：大寒症，非用斩关夺将之药不治，惟附子能通行十二经，无所不至，暖脾胃，通噎膈，疗呃逆，同干姜则热，同人参则补，同白术则除寒湿如神，为退阴回阳必用之味。近世疑而不用，直待阴极阳竭，而用已迟矣。古人于伤寒阴证厥逆直中三阴，及中寒来阴，虽身热而脉细，或虚浮无力者，惧用附子以温理之。或厥冷腹痛脉沉细，甚则唇青囊缩者，急须生附以温散之，东垣治阴盛格阳，面赤目赤，烦渴引饮，脉来七八至，按之即散者，余入都，闻有一人病火冲头痛颇重，延西医治之，用猪脬五，盛冰于中，头顶前后左右各悬其一。彼以为邪火上冲，用寒冰遏之，则火衰而痛可干。不知寒从外逼，火将内攻，症之轻者，不过多延时日，或可无虞，若遇重症，尤恐火气攻心，挽回莫及。在西人以寒治热，较俗工以风助火，已胜一筹，然何如用清下法折之，一服即平为愈乎。
面痛虚寒证
面为阳明部分，而阳维脉起于诸阳之会，皆在于面，故面痛多属于火。惟火有虚火，有实火。实者可清，虚者不可清，乙未年，我客居上海，有张姓妾，小产后，两眼中间，常有一星作痛，病已经年，问之诸医，莫名所以然。我切她的脉，细弱而迟，知道是平素血亏，小产后，血尤亏，血亏则气亏，气亏即火亏。遂合当归补血汤胶艾汤加吴萸、牛膝、肉桂为方，温补而愈，考《内经》察色篇，以两眼之间属心。经又云，心之合脉也。又云：诸脉皆属于目。西医亦云：心体跳动不休，周身血脉应之而动。可知脉为心血贯注之所，目又为血脉交会之所，今两眼间作痛，其为心中血虚无疑。何则？经云：诸痛皆属于心。又云：诸痛皆属于势。又云：心主血，心恶热。夫热，阳也。血，阴也。阴非阳不生，阴非阳不守，阴耗则阳气独吐，无所依附，势必循脉上浮，凑于两眼之间，安得不痛。我以补血为君，补气为臣，补火为佐，引热下行为使，病果应手而效。在麻衣相法，指两眼中央为山根，吾将以山根痛名之，附手眉棱痛、眼眶痈之后云。
心胸痛虚寒证
心痛一症，《灵枢》有肾心痛、胃心痛、脾心痛、肝心痛、肺心痛、真心痛之分。盖五藏之滞，皆为心痛。《金匮》用九痛丸，治九种心痛。后人以饮食气血寒热悸虫疰别之。虽祖此义，实未尽《内经》之旨，约丽论之，要不越阴阳虚实。然实而属阳者易瘳，虚而属阴者难愈。庚寅年冬天，我到山东，有友朱汉胎患心胸痛，或数日一发，或一日数发，如是者六七年。我切他的脉，濡数少神，知道是肝脾心痛，既寒且虚，给予温补重剂，服之，有小效，无大效。因思症系中空，甘草可满中，并能缓急止痛，仍前方加炙甘草至壹两，痛果大愈。但此症由境遇不遂所致，且患已数年，除根不易。其时有谓炙草一味，前方已用五钱，今又加至壹两，毋乃太多者。我说：甘草生用气平，炙用气温，其性能协和诸药，故有国老之称。昔仲景甘草汤、甘草芍药汤、甘草茯苓汤、炙甘草汤，以及麻黄，桂枝、葛根、青龙。理中、四逆、调胃，建中、柴胡、白虎等汤，无不重用甘草，惟遇呕吐肿满，酒客诸湿症，概禁不用，则以用药治病有宜忌之分也。世俗治病，下明宜忌，甘草一味，重用不敢，不用不能，凡立一方，但用数分，以为如此，乃两全之汁也。不知其计愈巧，其识愈庸。汪词庵曰：时医用甘草，不过二三分而止，不知始自何人，相习成风，审不可破，殊属可笑。曷为可笑，盖笑其庸耳。
腹痛宿证
腹痛一症，有热，有寒，有气，有血，有浊，有虫，有实，有虚，有内停饮食，有外感风寒，有霍乱，有内扁。治苟如法，虽数年宿恙，不难应手奏功。壬辰年冬天，我寓居天津，苏州严某，每于申时后，子时前，腹中作痛，上乘胸脘，甚至呕吐，静养则痛轻而缓，劳乏则痛重而急，病经十年，医治不效。我切他的脉，虚细中见弦数象，知道是气血两亏之体，中有酒积未清，故至申子二时，蠢然欲动。尝见书载祝由科所治腹痛症一则，与此情形颇合，惟彼专去病，故用二陈汤加川连、神曲，葛根、砂仁，而此则病经多年，正气既虚，阴血亦损。法当标本兼顾，因师其方，加参术地芍治之。服至十数剂，病果由重而轻，由轻而痊矣。当此症初愈时，十年夙恙，一旦奏功，人闻其异，索方视之，以为效固神奇，药乃平淡，莫名所以然。殊不知治病原无别法，不过对症用药而已。药与症合，木屑尘根，皆生人妙品，岂必灵芝仙草，始足却病以延年。
少腹痛火证
At the age of fifty, human vitality begins to decline. Beyond this age, one must rely on seasonal nourishment and care. If labor is excessive, decline will be severe. In the summer of the Gui Si year, I traveled to the capital for the imperial examinations. The Grand Minister of Justice (Da Sikou) invited me to treat him. He stated: "I had a minor ailment last winter, which flared up in spring. Despite continuous medical treatment, my condition worsened over several months. I have lost appetite, suffer from insomnia, experience facial flushing and a sensation of floating teeth, urinary difficulty, and constipation. I palpitate, sweat, feel weak in the limbs, and am fatigued. My hearing and vision are impaired, my voice is weak, and my spirit is confused." Upon taking his pulse, it felt wiry upon light pressure but thready and faint upon deep pressure. I determined this was due to a severe deficiency of Qi and Blood, with Wind-Yang failing to submerge. I initially prescribed a formula to nourish Yang and extinguish wind, supplemented with tonifying herbs. After five days, there was slight improvement, and his limbs gained strength. Subsequently, I used formulas to tonify Qi and nourish Blood, adjusting them frequently. Although his Heart Spirit remained somewhat deficient, his sleep and appetite normalized, and other symptoms resolved. Analyzing the etiology, his prolonged mental exertion damaged his Essence and Qi. The initial inappropriate treatment exacerbated his debility. Previously, in cases of exterior syndrome in deficient individuals, I emphasized supporting the Righteous Qi while dispelling pathogenic factors, addressing both root and branch. This advice aims to guide physicians to plan comprehensively for such weak conditions regarding convalescence. Two key herbs are essential: Deer Antler Lu Rong (Cervum Cornu) to tonify the Jing of the Du Mai (Governing Vessel), and Ginseng Ren Shen (Panax Ginseng Radix et Rhizoma) to tonify the Qi of the Five Zang Organs. Three principles are paramount: Yi (Nourishment/Enhancement) to boost Righteous Qi; Fu (Restoration) to recover Primordial Jing; Heng (Perseverance) as efficacy requires time. I observe that many people remain frail lifelong due to improper post-illness management, damaging their Qi. Others resume labor before recovery, causing relapse and irreversible Essence depletion. Some neglect necessary nourishment based on erroneous beliefs against tonic use, ruining progress. Only those who understand principles recognize Essence and Qi as treasures. Post-illness, when Yuan Qi is not yet restored, besides medication, daily life must be cautious, and diet regulated. One must avoid labor for months or years, not for idleness, but to cultivate Qi and store Jing, akin to preparing for significant endeavors. This aligns with the sages' practice of preserving the mind and nurturing nature.
Weak Syndrome of Dual Deficiency of Qi and Blood
Age twenty is termed "weak," meaning Qi and Blood are not yet fully充盈 (abundant). Illness caused by fatigue during this period leads to weakness and depletion. In the Ji Chou year, my relative Jiang Bingyan, aged nineteen, recovered from conjunctivitis in April. In May, he traveled to Chengjiang for exams and contracted Summerheat-Warmth upon returning north. His condition fluctuated between remission and relapse due to overexertion for weeks. Suspecting medical ineffectiveness, they prayed to deities and took "immortal prescriptions" for over a month, worsening the condition. I examined him: pulse threadlike and rapid; alternating chills and fever; coughing and wheezing; clear saliva with occasional blood streaks; spontaneous sweating; abdominal pain; exertion induced severe sweating and panting; profound prostration. Asked if curable, I replied that although depletion was established, given his youth, I would attempt rescue. I used Shi Quan Da Bu Tang (Ten Significant Tonification Decoction), Sheng Mai San (Generate the Pulse Powder), and Xiang Sha Liu Jun Zi Wan (Aucklandia and Amomum Six Gentlemen Pills), modifying them. Weeks later, persistent high fever indicated an exterior contraction. I prescribed Zi Su Yin (Perilla Decoction); mild sweating resolved the fever. Later, abdominal pain and dysentery appeared, indicating Righteous Qi restoring order and expelling pathogens. I added Huang Lian (Coptidis Rhizoma) to guide the pathology, stopping pain and dysentery. Later, anger rose, causing midday facial flushing, coma, and cold extremities, indicating Ming Men Fire floating upward. I prescribed Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), divided into three doses, taken at Si hour (9-11 AM) with hot water, while warming his feet with a stove. Floating fire subsided. Over 100 days, despite symptom changes, the core strategy remained consistent with minor adjustments, eventually achieving full recovery. Had my diagnosis been inaccurate or treatment inconsistent, delays would have occurred. After recovery, an elder sought treatment for decades-old ailments. I explained that success depended on both medicine and youth. Youth is like early spring grass, full of growth potential; old age is like autumn trees, showing decay. However, exceptions exist; some elders are stronger than weak youths, proving human effort can overcome destiny. Qi Qiu Zi said: Pines withstand frost by storing Righteous Qi; jade withstands fire by accumulating supreme Jing. Humans too can prevent disease and prolong life by storing Qi and Jing. I provided a regulating and tonifying prescription, and he left joyfully.
Cough: Internal and External Etiologies
The Lung is the canopy of the Five Zang Organs, pure and hollow, intolerant of foreign objects, reacting even to hair with cough. Coughs arise from external Six Qi pathogens or internal Seven Emotions and Six Desires. Treatment must address the cause. In winter of the Gui Si year, in Tianjin, I treated Gao Chengzhai's wife. She coughed from morning till night. Pulse was floating, deficient, fine, and rapid. Diagnosis: Cold binding the exterior, Yang Qi congested in the chest, unable to diffuse. Li Ge Jian (Diaphragm-Relieving Decoction) cured her instantly. Cao suffered dry coughs every afternoon for over a year. Pulse: only the left Chi position was rapid upon deep pressure. Diagnosis: Latent fire deep in the Yin aspect, rising to the Lung when Yin dominates in the afternoon. As Zhu Danxi noted, dry cough due to constrained fire is difficult to treat. I modified Qi Ju Di Huang Wan (Lycium, Chrysanthemum, and Rehmannia Pill), curing him in ten doses. In winter of the Bing Shen year, in Tianjin, Zhou Jing'e suffered severe coughing, unable to sleep. Pulse: fine and rapid in all positions, especially strong at Guan and Chi. Diagnosis: Warm pathogen in the Large Intestine ascending to the Lung. Qin Zhi Xie Huo Tang (Scutellaria and Anemarrhena Fire-Purging Decoction) cured him in ten doses. In early summer of the Ding You year, Jiang Jingquan's son had copious phlegm cough, bone/joint soreness, poor appetite, and fatigue. Pulse: slow and weak. Diagnosis: Spleen deficiency with Cold invasion. Li Zhong Tang (Regulate the Middle Decoction) cured him. These cases show coughs vary by exterior/interior, deficiency/excess, cold/heat. Treating according to pattern yields results. Ancients said: Though cough originates in the Lung, treatment is not limited to the Lung, as pathology may not solely reside there. Modern practitioners often indiscriminately use acrid/warm herbs for all coughs, leading to chronicity. By the time consumption develops, blaming Lung Qi/Yin deficiency ignores the root cause: damage from excessive acrid drugs. Addressing the cause prevents Lung injury.
Cough with Hemoptysis: Large Intestine Fire
Hemoptysis involves the Heart, Liver, Spleen, Lung, and Kidney. It manifests as coughing blood, vomiting blood, spitting blood, or expectorating blood with streaks. Differentiating exterior/interior, Yin/Yang, cold/heat, and deficiency/excess ensures cure. Fear of labeling it as "consumption" leads to hesitation and delay. In winter of the Geng Yin year, in Jinan, Yang Jingcheng had coughing blood. Previous doctors used Di Yu (Sanguisorbae Radix), Dang Gui Wei (Angelicae Sinensis Radix), Qian Hu (Peucedani Radix), and Ju Hong (Citri Reticulatae Pericarpium). Condition worsened. Pulse: soggy and rapid; right Chi rapid; yellow coating on tongue root. Diagnosis: Large Intestine fire rebelling upward, scorching Lung Metal, damaging blood vessels. Following Zhu Danxi, I used San Huang Xie Xin Tang (Three Yellows Heart-Purging Decoction). Hemoptysis stopped. Later, reducing the three yellows and adding Ren Shen (Ginseng) and Huang Qi (Astragali Radix) completed recovery. In January of the Bing Shen year, friend Li Jingyi had cough, then wheezing, then hemoptysis, plus severe lower back pain. Pulse: right Chi slippery and rapid. Diagnosis: Excessive Large Intestine fire ascending to the Lung. Huai Hua Jiang Qi Tang (Sophora Descending Qi Decoction) stopped bleeding after one dose. Two doses relieved back pain. Recovery followed. One patient was thin, the other fat. Fat people have dampness, requiring drying/clearing; thin people fear dryness, requiring moistening/clearing. Same pathology, different methods. Skeptics questioned Da Huang (Rhei Radix et Rhizoma)'s bitter-cold nature. I replied: Fire excess causes blood to leave its vessels; Da Huang purges excessive fire. Li Shicai noted ancients used Da Huang for consumption hematemesis because turbid Yin must descend for Clear Yang to ascend, and stasis must go for new blood to form. However, unskilled doctors using Da Huang for cold-deficiency injuries kill patients. Yang deficiency causes Yin to float; Ying Qi deficiency causes blood disorder. Li Zhong Tang or Gan Cao Gan Jiang Tang (Licorice and Ginger Decoction) warms the middle to return blood to vessels. Cold vs. Heat distinctions are crucial.
Wheezing due to Latent Summerheat
Wheezing arises from Wind-Cold, Summerheat-Dampness, Phlegm obstruction, Qi stagnation, Water Qi flooding, or Fire Evil rushing up. Differentiating exterior/interior, cold/heat, deficiency/excess is urgent. Unskilled doctors fail here. In Tianjin, Zhang Hanqing suffered severe wheezing, unable to sleep for a month. Pulse: deficient, fine, rapid. Diagnosis: Uncleared latent Summerheat from summer, Yin deficiency with Fire rising. Run Qi Tang (Moistening Qi Decoction) with Shi Gao (Gypsum Fibrosum) cured him in one dose, allowing sleep. Adjustments cured him in two weeks. Some criticized Shi Gao usage. I reasoned: Summerheat latent since June requires Gypsum to resolve. Criticism stemmed from ignorance or fear. Zhang Zhongjing used Gypsum in Xu Ming Tang and Yue Bi Tang. Li Shicai used Bai Hu Tang (White Tiger Decoction) for summerheat wheezing. Ancients relied on Gypsum for Fire Evil wheezing. Using Gypsum for Summerheat wheezing is like using Gan Jiang (Zingiberis Rhizoma) for Cold wheezing, Ren Shen for Deficient wheezing, or Su Zi (Perillae Fructus) for Excess wheezing. Once the pattern matches, use without doubt. Commoners speak nonsense. Such wheezing is stubborn and prone to relapse. Precision is vital. In winter of the Bing Shen year, Liu Weizhai's son had episodic wheezing with headache and fever. Pulse: right deficient/rapid, left faint. Diagnosis: Yin deficiency, Yang excess. Dong Di San Huang Tang (Winter, Rehmannia, and Three Yellows Decoction) calmed wheezing. Switching to Ren Shen and Huang Qi restored health. Relapse in summer was misdiagnosed by others as exterior cold or middle deficiency, worsening the condition. I used clearing/nourishing methods again, curing him in ten days. Wheezing is often a chronic issue due to constitutional bias. Physicians must differentiate Yin/Yang and deficiency/excess accurately.
Vomiting and Hiccups: Deficiency-Cold
Vomiting and hiccups vary by Qi/Blood amount and Cold/Heat/Deficiency/Excess. Excess-Heat responds quickly to clearing/purging; Deficiency-Cold requires slow warming/tonifying. In Tianjin, Zhang Hongqing had chronic vomiting triggered by cold wind, producing cold saliva. Pulse: deep, fine, slow. Diagnosis: Long-standing Cold accumulation. Strong hot herbs were needed to dissipate deep cold and restore dispersed Yuan Yang. Si Ni Tang (Counterflow Decoction) with modifications, including large doses of Fu Zi (Aconiti Lateralis Radix Praeparata, 1 liang per dose), cured him after hundreds of doses. Critics questioned the high dose of Fu Zi. I answered: Severe Cold requires decisive herbs. Fu Zi circulates through the Twelve Meridians, warms the Spleen/Stomach, opens blockage, treats hiccups. With Gan Jiang it heats, with Ren Shen it tonifies, with Bai Zhu it removes damp-cold. It is essential for rescuing Yang. Modern hesitation leads to late treatment. Ancients used Fu Zi for Sha Yin syndromes, Jue Ni, and cold invasion with faint pulses. For cold extremities and abdominal pain, raw Fu Zi was urgent. Dong Yuan treated Yin excess repelling Yang (false heat) with warming. I heard of a Western doctor treating severe headache/fire with ice bladders suspended around the head, believing cold suppresses fire. This forces cold inward, potentially harming the Heart. While Western cold therapy beats folk wind-fire theories, clearing/purging methods are superior for immediate relief.
Facial Pain: Deficiency-Cold
The face belongs to the Yangming channel, and the Yang Wei Mai (Yang Linking Vessel) converges there, so facial pain often relates to Fire. Fire can be Deficient or Excess. Excess clears; Deficient does not. In Shanghai, a concubine had pain between her eyes after a miscarriage for a year. Pulse: fine, weak, slow. Diagnosis: Chronic Blood deficiency worsened by miscarriage. Blood deficiency leads to Qi deficiency, which leads to Fire deficiency. I combined Dang Gui Bu Xue Tang (Danggui Tonifies the Blood Decoction) and Jiao Ai Tang (Donkey-Hide Gelatin and Mugwort Decoction) with Wu Zhu Yu (Evodiae Fructus), Niu Xi (Achyranthis Bidentatae Radix), and Rou Gui (Cinnamomi Cortex) to warm and tonify, curing her. 《Nei Jing》 states the area between eyes corresponds to the Heart. The Heart governs vessels; vessels connect to the eyes. Western medicine notes heart pulsation drives blood flow. Thus, eye pain indicates Heart Blood deficiency. Classics state: All pain belongs to the Heart; Heart governs Blood and dislikes Heat. Heat is Yang; Blood is Yin. Yin relies on Yang for generation and retention. Yin consumption leaves Yang unanchored, floating up to the eyes, causing pain. I used Blood tonification as Sovereign, Qi tonification as Minister, Fire tonification as Assistant, and heat-guiding herbs as Envoy. Success followed. In physiognomy, this point is Shan Gen (Mountain Root). I name it Shan Gen Pain.
Chest and Heart Pain: Deficiency-Cold
《Ling Shu》 classifies Heart Pain into Kidney, Stomach, Spleen, Liver, Lung, and True Heart Pain. Obstruction in any Zang can cause Heart Pain. 《Jin Gui Yao Lue》 uses Jiu Tong Wan (Nine Pain Pill) for nine types. Later scholars differentiated by food, Qi, Blood, Cold, Heat, palpitations, parasites, etc., following 《Nei Jing》 principles of Yin/Yang and Deficiency/Excess. Excess-Yang is easier to cure; Deficiency-Yin is harder. In Shandong, friend Zhu Hantai suffered chest/heart pain for 6-7 years. Pulse: soggy, rapid, lacking spirit. Diagnosis: Liver/Spleen Heart Pain, Cold and Deficient. Warming/tonifying helped slightly. I realized the pain involved emptiness. Gan Cao (Licorici Radix et Rhizoma) fills the center and relieves urgency/pain. Adding Zhi Gan Cao (Prepared Licorice) to 1 liang greatly reduced pain. However, chronic cases linked to emotional distress are hard to cure permanently. Critics questioned the high dose of Zhi Gan Cao. I explained: Raw Gan Cao is neutral; Prepared is warm. It harmonizes formulas, earning the title "State Elder." Zhang Zhongjing heavily used Gan Cao in many formulas (Gan Cao Tang, Gan Cao Gan Jiang Tang, Ma Huang Tang, Gui Zhi Tang, etc.), except in cases of vomiting, distension, or dampness. Modern doctors fear heavy use, using tiny amounts, thinking it safe. This reflects mediocrity. Wang Ci'an mocked doctors limiting Gan Cao to 2-3 qian as ignorant tradition.
Abdominal Pain: Chronic Syndrome
Abdominal pain has many causes: Heat, Cold, Qi, Blood, Turbidity, Parasites, Excess, Deficiency, Food stagnation, Exterior Cold/Wind, Cholera, etc. Correct treatment cures even chronic cases. In Tianjin, Yan from Suzhou had abdominal pain from Shen hour (3-5 PM) to Zi hour (11 PM-1 AM), radiating to chest/epigastrium, with vomiting. Rest eased it; fatigue aggravated it. Ten years duration, untreatable. Pulse: deficient/fine with wiry/rapid elements. Diagnosis: Dual Qi/Blood deficiency with residual Wine Dampness activating at specific hours. A "Zhu You" (shamanistic) case matched this, using Er Chen Tang with Huang Lian, Shen Qu, Ge Gen, Sha Ren to remove disease. However, this patient had long-term deficiency. I balanced root and branch, adding Ren Shen, Bai Zhu, Shu Di Huang, Bai Shao to Er Chen Tang. Ten doses reduced severity; continued use cured him. People marveled at the simple prescription's efficacy. Healing depends on matching herbs to patterns, not magical ingredients. Lingzhi is not required if the formula fits the syndrome.
Lower Abdominal Pain: Fire Syndrome